title: Flow reversal versus filter protection: a pilot carotid artery stenting randomized trial.
abstract: BACKGROUND
  Carotid artery stenting (CAS) has become an alternative treatment for patients presenting symptomatic carotid artery stenosis. The improvement in clinical outcomes with CAS has been associated with the development of embolic protection devices. The trial aim is to compare flow reversal versus filter protection during CAS through femoral access.
  
  
  RESULTS
  Patients were randomly enrolled in CAS using flow reversal or filter protection. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS. The secondary end points included major adverse cardiac and cerebrovascular events, transient ischemic attack, and definitive ischemic brain lesions on fluid-attenuated inversion recovery magnetic resonance image at a 3-month follow-up. Ischemic brain lesions were assessed by a 3T magnetic resonance image. Neurological outcomes were evaluated by means of the National Institutes of Health Stroke Scale and the modified Rankin Scale (mRS). Forty consecutive patients were randomly assigned. Compared with flow reversal (n=21), filter protection (n=19) resulted in a significant reduction in the incidence (15.8% versus 47.6%, P=0.03), number (0.73 versus 2.6, P=0.05), and size (0.81 versus 2.23 mm, P=0.05) of new ischemic brain lesions. Two patients, 1 from each group, presented transient ischemic attack at 3-month follow-up. There were no major adverse cardiac and cerebrovascular events in the hospital or at 3-month follow-up.
  
  
  CONCLUSIONS
  In this small sample size trial, filter protection was more effective than flow reversal in reducing ischemic brain lesions during CAS through femoral approach.
  
  
  BACKGROUND
  http://portal2.saude.gov.br/sisnep/. Unique identifier: 0538.0.004.000-10.
authors.affiliation: Division of Interventional Neuroradiology, Division of Neuroradiology, and Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Luis Henrique de
authors.initials: LH
authors.lastname: Castro-Afonso
authors.forename: Lucas Giansante
authors.initials: LG
authors.lastname: Abud
authors.forename: Jaicer Gonçalves
authors.initials: JG
authors.lastname: Rolo
authors.forename: Antônio Carlos dos
authors.initials: AC
authors.lastname: Santos
authors.forename: Lívia de
authors.initials: Ld
authors.lastname: Oliveira
authors.forename: Clara Monteiro Antunes
authors.initials: CM
authors.lastname: Barreira
authors.forename: Tonicarlo Rodrigues
authors.initials: TR
authors.lastname: Velasco
authors.forename: Octávio Marques
authors.initials: OM
authors.lastname: Pontes-Neto
authors.forename: Daniel Giansante
authors.initials: DG
authors.lastname: Abud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000601:surgery*; D002406:Catheterization, Peripheral; D057505:Embolic Protection Devices; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012039:Regional Blood Flow; D015607:Stents / Q000706:statistics & numerical data
keywords: carotid artery angioplasty stenting; embolic protection devices; flow reversal; ischemic brain lesions; magnetic resonance image